Provider Demographics
NPI:1376792416
Name:AT HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:AT HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONILO
Authorized Official - Middle Name:
Authorized Official - Last Name:STA.MARIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:818-757-3333
Mailing Address - Street 1:5530 CORBIN AVE
Mailing Address - Street 2:STE 228
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2914
Mailing Address - Country:US
Mailing Address - Phone:818-757-3333
Mailing Address - Fax:818-757-3343
Practice Address - Street 1:5530 CORBIN AVE
Practice Address - Street 2:STE 228
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2914
Practice Address - Country:US
Practice Address - Phone:818-757-3333
Practice Address - Fax:818-757-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-13
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000976251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health